ivt procedure i

8/3/2019 IVT Procedure I

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INTRAVENOUS

THERAPY

Dale Brian T.Gaviola,WOCN

PROCEDURE I

SETTING UP / CHANGING / DISCONTINUING

I.V. INFUSION



Indications

1. Establish or maintain a fluid or electrolyte balance.

2. Administer continuous or intermittentmedication.

3. Administer bolus medication.

4. Administer fluid to keep vein open

(KVO).



5. Administer blood or blood

components.

6. Administer intravenous anesthetics.

7. Maintain or correct a patient's

nutritional state.

8. Administer diagnostic reagents.

9. Monitor hemodynamic functions.



IV Devices

Types of IV needles

and catheters:

STEEL NEEDLES

Example: Butterfly catheter. They are named after the wing-like plastic

tabs at the base of the needle. They are used to deliver small

quantities of medicines, to deliver fluids via the scalp veins in

infants, and sometimes to draw blood samples (although not

routinely, since the small diameter may damage blood cells). These

are small gauge needles (i.e. 23 gauge).



OVER THE NEEDLE CATHETERS

Example: peripheral IV catheter. This is the kind of catheter you will

primarily be using.



INSIDE THE NEEDLE

CATHETERS

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Example: midline andextended dwell catheters

This is a typical

catheter over the

needle arrangement

This is an inside

the needlecatheter

arrangement



AND NOW, A WORD ABOUT GAUGES:

Catheters (and needles) are sized by their diameter,

which is called the gauge. The smaller the diameter,

the larger the gauge. Therefore, a 22-gauge catheter

is smaller than a 14-gauge catheter. Obviously, the

greater the diameter, the more fluid can be delivered.

To deliver large amounts of fluid, you should select alarge vein and use a 14 or 16-gauge catheter. To

administer medications, an 18 or 20-gauge catheter

in a smaller vein will do.



16G 18G 20G 22G 24G 24G**



3 MAIN TYPES OF IV FLUIDS

ISOTONIC FLUIDS

HYPOTONIC FLUIDS

HYPERTONIC FLUIDS



ISOTONIC FLUIDS

CLOSE TO OSMOLARITY AS SERUM. STAY INSIDE

INTRAVASCULAR COMPARTMENT THUS EXPANDING IT

CONTAINS APPROXIMATELY EQUAL NUMBER OF

MOLECULES AS SERUM SO FLUID STAYS WITHININTRAVASCULAR SPACE

CAN BE HELPFUL IN HYPOTENSIVE AND HYPOVOLEMIC

PTS.

CAN BE HARMFUL. RISK OF FLUID OVERLOADING ESP

IN PTS WITH CHF AND HPN

EX. LR, NS



HYPOTONIC FLUIDS

HAVE LESS OSMOLARITY THAN SERUM

DILUTES SERUM WHICH DECREASES SERUMOSMOLARITY

CAN BE HELPFUL WHEN CELLS ARE DEHYDRATEDSUCH AS A DIALYSIS PT. ON DIURETIC THERAPY

MAY ALSO BE USED FOR HYPERGYCEMIC PTS.LIKE DIABETIC KETOACIDOSIS

CAN BE DANGEROUS TO USE BECAUSE OF THE

SUDDEN FLUID SHIFT FROM THE INTRAVASCULARSPACE TO THE CELLS WHICH CAN LEAD TOCARDIOVASCULAR COLLAPSE AND INCREASEDICP



CONTAIN LOWER NUMBER OF MOLECULES THAN

SERUM SO THE FLUID SHIFTS FROM THE IV SPACE

TO THE INTERSTITIAL SPACE

THIS DECREASES THE INTERSTITIAL SPACEOSMOLARITY WHICH THEN CAUSES THE FLUID TO

MOVE INTO THE CELLS

EX. D5 NS .45



HYPERTONIC FLUIDS HAVE A HIGHER OSMOLARITY THAN SERUM PULLS FLUID AND ELECTROLYTES FROM THE

INTRACELLULAR AND INTERSTITIAL

COMPARTMENTS IMTO THE INTRAVASCULAR

COMPARTMENT CAN HELP STABILIZE BLOOD PRESSURE,

INCREASE URINE OUTPUT, AND REDUCE EDEMA

CARE MUST BE TAKEN WITH THEIR USE

DANGEROUS IN THE SETTING OF CELLDEHYDRATION

EX. 9.0% NS, BLOOD PRODUCTS,

ALBUMIN



CONTAIN A HIGHER NUMBER OF MOLECULES

THAN THE SERUM SO THE FLUIDS SHIFT FROM

THE INTERSTITIAL SPACE TO THE

INTRAVASCULAR SPACE

THIS DECREASES THE INTERSTITIAL SPACE

OSMOLARITY THAT THEN CAUSES FLUID TO LEAK

OUT OF THE CELLS



Procedure I

A. Setting up IV infusion



1. Verify doctor¶s order and make IV

label.

2. Observe ten (10) Rs when preparing

and administering IVF



10 GOLDEN RULES on drug

administration Obtain a complete drug history

Identify if the client has any drug allergies

Know potential drug effects, drug-drug interactions and compatibilities.

Teach your client about the drug he is receiving

Administer the right drug

Administer the right drug to the right patient

Administer the right dose

Administer the right drug at the right route

Administer at the right time and frequency

Right documentation of each drug you administer

* to protect your patients and your license as a nurse, follow theseguidelines for avoiding medication errors.



3. Explain procedure to the patient and/or

significant others , secure consent if

necessary.

4. Assess patient¶s vein; choose appropriate

vein ;location,size condition



VEINS OF THE HANDDIGITAL

DORSALIS VEIN

DORSAL

METACARPAL VEINS

DORSAL VENOUS

NETWORK

CEPHALIC VEIN

BASILIC VEIN



AVEINS OF THE FOREARM

CEPHALIC VEIN

MEDIAN CUBITAL VEIN

ACCESORY CEPHALIC

VEIN

BASILIC VEIN

CEPHALIC VEIN

MEDIANANTEBRACHIAL VEIN



5. Wash hands and maintain asepsisthroughout the preparation during the

therapy .

6. Prepare the necessary materials for

procedure



1. IV tray with solution

2. Administration set

3. IV cannula

4. Forceps soaked in antiseptic solution

5. Alcohol prep pads, cotton balls with alcohol6. Plaster

7. Tourniquet

8. Gloves

9. IV splint10. IV hook

11. 2x2 gauze or transparent dressing



7. Check the sterility andintegrity of the IV solution ,IV set and other devices

8. Place IV label on IVF bottle

Patients name

Room number

Solution,

drug incorporation

Bottle sequenceDuration



9. Open the seal aseptically of the solutionand disinfect rubber port with cotton ball

with alcohol.

10. Open administration set aseptically and

close the IV clamp



11. Spike the infusate aseptically.

12. Fill drip chamber to at least half

and prime tubings.

13. Remove air bubbles any and pull

back the cover to the distal end of the

I.V. tubing.

( get ready for IV insertion)



B. Changing an IV infusion



14. Verify doctor¶s order ; countercheckthe ff:

a. IV label

b. IV Card

c. Infusate sequence

d. Type

e. Amount

f. Additives

g. Duration of infusion



15. Observe ten (10) Rs.

16. Explain procedure to the patient andassess IV site for redness, swelling, pain ,etc.

17.Check date of IV insertion; re-site if 48-72hours has lapsed

18. Check date of changing IV tubings, changeif due for changing

(change IV tubings within 72 hours)



19. Wash hands before and after the procedure

20. Prepare necessary materials

a. IV solution

b. IV label

c. Disinfectant

d. Kidney basin

e. IV tray



21. Check sterility and integrity of IV

solution.

22. Place IV label on the IV bottle

23. Calibrate new IV bottle according to

duration of infusion.



24. Open and disinfect rubber port of IV

solution to follow.

25. Close IV clamp or kink tubing and spike thecontainer aseptically

26. Regulate the flow rate based on duration of infusion . Remove air bubbles (if any)

27. Reasure patient and significant others.



Nurse Alert !28. Discard all waste materials according to

MMDA Ordinance # 16

29. Document accordingly and endorse to

incoming shift,



C. Discontinuing an I.V. Infusion



30. Verify written doctor¶s order to

discontinue IV including IV medicines.

31. Observe ten (10) Rs

33. Assess and inform the patient of the

order and of any ordered medicines



33. Prepare the necessary materials :

a. IV tray or injection tray

b. Cotton balls with alcoholc. Plaster

d. pick-up forceps in antiseptic solution

e. Kidney basin



34. Wash hands before and after procedure

35. Close IV clamp of the tubing .

36. Moisten adhesive tapes around the IV

catheter with cotton ball with alcohol.



37. Use pick-up forceps to get cotton ball

with alcohol and without applyingpressure , remove needle or IV catheter

then immediately apply pressure over veni

puncture site.

38. Inspect IV catheter for completeness

39. Place dressing over venipuncture site.



40. Discard all waste materials including the

IV cannula according to MMDA Ordinance# 16

41. Reassure patient.

42. Document time of discontinuance, status

of insertion site and integrity of IV catheter and endorsee accordingly.



NURSE ALERT !: Don·t forget to document your

actions!



Thank you for your

Attention!

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